Pediatric Eye Assessment & Common Problems

Front 1

Myopia

Back 1

Nearsighted

Front 2

Hyperopia

Back 2

Farsighted

Front 3

Strabismus

Back 3

ocular misalignment to 5% of children that can lead to...ambylopia. Strabismus often treated first with muscle training with surgery limited to severe abnormalities.

Front 4

Amblyopia

Back 4

inadequate visual stimulation of the brain during critical visual development, may result in irreversible blindness. Can occur following strabismus, injury, severe myopia, retinopathies, tumors, or cataracts. Must be treated early or is irreversible. Does not usually occur after age 5.

Front 5

Diplopia

Back 5

Double vision

Front 6

Esotropia

Back 6

inward gaze- most common

Front 7

Exotropia

Back 7

outward gaze

Front 8

Hypertropia

Back 8

upward gaze

Front 9

Hypotropia

Back 9

downward gaze

Front 10

Hirschberg Test (corneal light reflex)

Back 10

shining a light towards the eyes, light should be reflected at exactly the same spot in the two corneas.

Front 11

Anisocoria

Back 11

disequal pupils, common to 20-25% of population, may vary from day to day, usually 1mm, same in bright or dim light, no dilation lag

Front 12

Horner's syndrome

Back 12

smaller pupil, ptosis, hypochromic iris (if congenital) from cervical sympathetic pathway abnormality, usually more pronounced in dim light with dilation lag

Front 13

Epicanthal Folds

Back 13

skin fold from inner canthus to mid-upper eyelid, becomes less noticeable throughout childhood (common findings in Down Syndrome)

Front 14

Brushfield spots

Back 14

freckled spots on iris (common findings in Down Syndrome)

Front 15

Hypertelorism

Back 15

increased distance between nasal walls of orbits(common findings in Down Syndrome)

Front 16

Exophtalmos

Back 16

outward displacement or protuberance of the eye

Front 17

Proptosis

Back 17

outward displacement of an organ, i.e. eye( so basically synonymous with exophthalmos)

Front 18

Retinoblastoma

Back 18

most common intraorbital malignancy in children
-usually diagnosed between ages 1 to 5 years
-most detected by parents noting leukocoria ( an abnormal white reflection from the retina of the eye)

Front 19

Neuroblastoma

Back 19

most common orbital malignancy in children
-proptosis and ecchymosis

Front 20

Microphthalmos

Back 20

smaller eye(s) may be associated with other congenital opthalmic problems, i.e. cataracts

Front 21

Buphthalmos

Back 21

distended, enlarged eye from intraoccular pressure, i.e. glaucoma or tumor

Front 22

Glaucoma

Back 22

corneal edema and increased intraoccular pressure
-photophobia, blepharospasm (any abnormal contraction or twitch of the eyelid), increased tearin, irregular cornal, & blurred red reflexes, corneal hazy, thin bluish sclera, increased myopia as globe size increases
-may lead to amblyopia if untreated

Front 23

Coloboma

Back 23

2 forms:
1. cleft of the eyelid may be upper and usually associated with syndromes such as Goldenhar or Treacher-Collins
2. Iris defect usually inferior and nasal in location.
-may be isolated defect or associated with other syndromes

Front 24

Ptosis

Back 24

dysfunctional levator muscle.
-may develop after chronic steroid eye drop use or chronic irritation
-usually a sigh of some other disorder

Front 25

Hordeolum

Back 25

Inflammation of gland of Zeis, usually painful, inflamed lid.
- remember that "hordeolum hurts"
- casually referred to as "styes"
- antibiotics rarely warranted, warm compress for comfort

Front 26

Chalazion

Back 26

inflammation of meibomian glands, painless inflamed lid tarsus.
- may leave scar nodule on lid margin
- casually referred to as "styes"
- antibiotics rarely warranted, warm compress for comfort

Front 27

Dacryocystitis/stenosis

Back 27

an infection of the nasolacrimal sac, frequently caused by nasolacrimal duct obstruction
-30% newborns complete patency of caniculi (nasolacrimal duct) not present-- very common
-usually worsens with URI, rhinorrhea not present due to obstruction
- massage duct until 6 months of age usually recommended (effectiveness if questioned)

Front 28

Conjunctivitis

Back 28

inflammation of conjunctiva (clear epithelial covering of sclera & inner eyelids; mucus membranes)
- most common ophthalmic problem noted in primary care
- may be cause by infections (bacterial/viral), toxins, or allergens
- neonate after 2 days of age most commonly from gonococcus or chlamydia which is associated with systemic disease
- viral form highly contagious

Front 29

Blepharitis

Back 29

erythema, crusting of the eyelash border
-may be related to seborrhea
- usually chronic
- more common in children with Down syndrome

Front 30

Cellulitis

Back 30

Periorbital: preseptal, eyelid and facial involvement, chemosis, and purulent drainage, usually unilateral
Orbital: septal pain, decreased ocular motility, proptosis, vision loss, abnormal pupil response, may spread intracranially, have dental disease, sinusitis, or metastases
- both may initiate systemic infection
- can be very difficult to differentiate
-both occur quickly -- overnight

Front 31

Cataract

Back 31

a clouding that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light
- May be congenital or acquired; unilateral or bilateral.
- Amblyopia develops quickly

Front 32

Corneal Abrasion

Back 32

Cornea is clear, epithelia layer with rich sensory innervation
-extremely common
-especially with disabled who are unable to inform caretaker of problem
-treat with antibiotics and eye patching for no longer than 24
- if pain continues for >24H refer to ophthalmologist

Front 33

Chemical injuries

Back 33

- only true EMERGENT ophthalmic emergency
-every second of ophthalmic contact with chemical can lead to further tissue/vision damage.
- must flush eye(s) immediately
- Flush with at least 2 liters of water or LR per eye (when in doubt do both eyes)...until pH is 7
- alkali products common in home/garage are most damaging (household cleaners, garden products, automotive lubricants)
- home- flush eye under faucet until paramedics arrive (never drive to hospital/MD-- time is vision)

Front 34

Hyphema

Back 34

ruptured iris blood vessel or ciliary body resulting in blood and increased pressure in the anterior chamber
- may have significant concurrent, globe, orbit, or head injury
-rebleeding in 3-5 days a concern
-AT RISK FOR GLAUCOMA & VISION LOSS
-may require sx intervention (keep NPO and HOB 30)
-treatment contraversial (include: bedrest, eye patching, avaoiding val salva maneuver, acetazole &/or atropine to reduce intraocular pressure, and Amicar to reduce bleeding potential)

Front 35

Orbital Fractures

Back 35

May have significant concurrent, globe or head injury
-most common is orbital fracture w/ entrapped musle to maxillary sinus (may need sx --keep NPO)
- orbital roof fractures may allow CSF drainage, lateral walls may damage optic nerve
- waters view radiographs and CT of orbit and sinuses helpful

Front 36

Lid Lacerations

Back 36

- laceration and animal bites may have non-apparent penetrations of the globe or cranial vault.
- Canalicular and nasolacrimal duct injury common with lower, medial wounds.
- Repair to"gray line" or conjunctiva/skin border must be meticulous for good cosmetic effect.
- Eyebrows are never to be shaved prior to skin closure
- keep NPO for sedation or surgical correction

Front 37

Penetrating Trauma

Back 37

- May have significant, concurrent skin, orbital, sinus, or cranial vault injury
- sclera tissue repairs itself very quickly even immediate exams difficult
- Do not remove embedded foreign objects (immobilize object and patient)
- waters view radiographs and CT may be helpful
- retained wood reported to develop severe fungal infections
-may require sx intervention (keep NPO & HOB 30)